By Rhi Kemp-Davies (COSRT Psychosexual Therapist and Clinical Supervisor)

“Remind yourself that the whole body has the capacity to feel pleasure, and although penetrative sex is the most understood way to have sex, it is only one of hundreds of ways to have sex.”

If you experience pain in your genitals, it can be a difficult topic to discuss with people close to you. If you have a partner, they may know, but what to what degree? And what have you done about it as a couple? You also may have taken it to your GP, or to your sexual health clinic, and their response might vary from the response another professional might give.

Genital pain can happen to anyone with any genitals for various reasons.

You might have a vagina and find it painful when anything is inserted.
You might have a penis that hurts when it gets erect.
You might be intersex with a history of nonconsensual surgery done to your genitals and have some ongoing pain from it.
You might also be trans/nonbinary and either have had bottom surgery, or the hormones you are taking for your transition affect your nerve endings and tissue.

From Medical Labels to Everyday Experiences

These are just a few of many experiences of genital pain. If you looked at the NHS, DSM 5 or ICD 11, you will find various words to describe genital pain, including dyspareunia, vulvodynia, vestibulodynia, prostatitis, chronic pelvic pain syndrome, pudendal neuralgia. We can’t ignore how having endometriosis, fibroids, cysts, tight foreskin or colon issues can affect the experience of genital pain either, as well as being pregnant, post childbirth, peri/menopausal and recovering from or living with cancer, especially if it is cancer around that area.
 
The internet can be a great resource to find ways to manage or ‘fix’ this pain, and it can also be overwhelming, full of contradicting opinions/advice and over-run with ‘aids’, medication or remedies to help. Although there is a huge number of differences between everything listed above, there are some common experiences for people who experience them, including:
 
Feeling ‘broken’
Feeling lonely
Avoiding sex
Persevering with sex despite it being painful

Breaking the Silence, Exploring the Options

Genitals and the areas surrounding the genitals are still seen by many as taboo, and because of this, it can feel a lot more difficult to ask for help because of embarrassment or even shame. Sadly, more and more people are choosing to put their sex life to the side rather than pay attention to it and seeing how they can have sex that feels more pleasurable.

There are some options of medication for genital pain, like topical cream, hormone treatment, painkillers or nerve blockers, as well as specific medication for specific STI’s, and we would recommend you visit your GP, pharmacist, or a specialist to discuss this. Not everybody can have pain relief, though, and it might not be enough.

When the Body Braces for Pain

If you expect pain to happen when you have sex, you will naturally (and understandably) tense up and disengage. By doing this, you are alerting your body to threat. If the body tenses up, it the heart will beat faster, adrenaline will pump to your muscles to brace for ‘impact’, and it will want to protect itself.

The body finds it very difficult to make space for desire and arousal when it is in this state. This is also why you might want to disengage, because your brain will find it a real challenge to look for sexual cues when it is preparing itself for pain.

When your body then gets into the habit of going through this every time you entertain or have sex, which slowly creates a ‘muscle memory’, which makes it easier and easier for the body to go into this mode when sex is introduced.

Reconnecting with Pleasure

To keep this from happening, I want to invite you to try the following:

Remind yourself that the whole body has the capacity to feel pleasure, and although penetrative sex is the most understood way to have sex, it is only one of hundreds of ways to have sex

Start, by yourself, mapping your body. What this means is for you to run your hand across every part of your body to see what feels good. Experiment with how your run your hand – apply more pressure, less pressure, use your fingernails, other parts of your hand. Notice what parts of your body feel a pleasurable sensation. Make a note of this in writing if it helps.

Doing this will also give you a chance to see what doesn’t feel so pleasurable.

Keeping a Pleasure Diary

After you have mapped the sensations on your body, you now have the beginning of a blueprint which you can then build on and adapt.

If you have difficulty noticing pleasure, keep a pleasure diary for a couple of weeks. Every day, note 3-5 different experiences of non-sexual pleasure you feel on your body – whether it is a hot drink in your mouth, the feeling of water on your body when you shower, a satisfying stretch, a pet on your lap or receiving a kiss on the cheek from a partner. The pleasure diary isn’t about sex, it is about paying attention to sensations on your body that feel nice.

When you feel more in touch with your senses, you then need to start developing confidence in requesting this kind of touch. This isn’t necessarily easy! It entails you believing that the touch you enjoy is valid, and that it isn’t ‘less than’ traditional intercourse. It is a strong discourse in a lot of cultures, implicitly and explicitly, so to step outside of this narrow belief of what sex is isn’t easy, but it’s worth it!

From First Dates to Sex Life Resets

If you don’t have a sexual partner, and you actively date, it is worth having a few dates with someone you like so you feel comfortable enough around them, and can trust them enough with respecting when you say ‘no’ and to listen to your desires. It is sexier than you think to hear someone say what they enjoy doing during sex.

If you are partnered, the 3 minute game is a lovely way to start playing with requesting how to be touched. You can also try a ‘sex life reset’ by discussing with each other something you would like to keep, discard and introduce in your sex life. The Havelock clinic has a template here.

Desire and Arousal Matters

Finally, believe it or not, arousal helps! If you have a vagina, it will start to ‘tent’ when you get aroused, making receiving penetration easier. This blog post might help you understand desire and arousal more.

Cynefin offers low cost sex therapy and can help you build on this work, so get in touch for further support.

How Therapy Can Help?

If you experience sexual problems, you may want quick answers. That’s natural and understandable. But sex can be complex, and instead of searching for a quick fix, we might try to understand what our sexual problems are telling us.

Talk therapy offers a secure place to slow down and reflect on unhealthy patterns, emotional blocks that affect closeness, past trauma, and fears or beliefs around sex and intimacy. You don’t need to have all the answers. Psychosexual therapy can be a great place to explore what feels difficult and discover new ways to connect with yourself and others. Our therapists at Cynefin Therapy will guide you while you’re exploring your emotions, thoughts, and sexuality. Reach out today to learn how we can help you.